1. Field of the Invention
The present invention relates to endotracheal tube holder devices and methods for retaining an endotracheal tube in a set position after a patient is intubated. More particularly, the present invention relates to endotracheal tube holders that strap to the head of an intubated patient and physically engage the endotracheal tube, thereby retaining the endotracheal tube in one position.
2. Prior Art Description
To properly perform an endotracheal intubation procedure, the distal end of an endotracheal tube must be positioned within a patient's trachea. The trachea is the region of the throat that lays between the larynx and the left and right bronchi of the lungs. During the entire intubation period, the distal end of the endotracheal tube must be retained within the confines of the trachea. If the distal end of an endotracheal tube were to move out of the trachea, above the larynx, the vocal cords may close, preventing the intubation of the lungs. This can cause suffocation. If the vocal cords do not close gastric content aspiration could occur.
If the distal end of the endotracheal tube descends below the trachea, the endotracheal tube typically enters the right mainstream bronchus of the lung. Accidental right mainstream endotracheal intubation is a common cause of pulmonary morbidity (e.g. lung collapse, hypoxemia, cardiac arrest, etc.) in all patients undergoing an endotracheal intubation procedure. Accidental right mainstream endotracheal intubation occurs when an endotracheal tube is advanced too far within a patient's trachea. In such a situation, the endotracheal tube enters the right bronchus of the lung causing the left lung to collapse. Such accidental right mainstream endotracheal intubation results in many deaths each year and causes surviving patients to require extensive pulmonary care.
In the prior art, there exist many features designed into endotracheal tubes to assist in positioning the distal end of the endotracheal tube within a patient. One of the most common features designed into prior art endotracheal tubes is the use of depth indicators printed on the exterior surface of the endotracheal tube. The depth indicators are indicative of the distance between the distal end of the endotracheal tube and the indicator marking itself. For example, if an orally applied endotracheal tube is advanced down a patient's throat until an indication of fifteen centimeters is seen at the patient's mouth, the person administering the endotracheal tube can see that the endotracheal tube has been advanced fifteen centimeters into the patient's mouth and into the patient's throat. By knowing the size of the patient, the person administering the endotracheal tube can estimate the proper intubation distance needed to position the distal end of the endotracheal tube within the patient's trachea.
However, even if an endotracheal tube is initially properly positioned, the position of the tube may change during the time of intubation. For example, a patient's body may be moved by a doctor during an operation. The change in the position of the body may change the position of the trachea relative the endotracheal tube, thereby causing the distal end of the endotracheal tube to leave the trachea.
Recognizing the need to retain the distal end of an endotracheal tube in the trachea during intubation, many devices have been developed in the prior art that physically anchor the endotracheal tube to the body. By anchoring the endotracheal tube to the body, it is hoped that the endotracheal tube will move with the body, thereby causing the positional relationship between the distal end of the endotracheal tube and the trachea to remain constant.
One of the most common devices used to retain an endotracheal tube in place is an endotracheal tube holder. Endotracheal tube holders, such as those exemplified by U.S. Pat. No. 5,402,776 to Islava, entitled ENDOTRACHEAL TUBE HOLDER and U.S. Pat. No. 5,345,931 to Battaglia, also entitled ENDOTRACHEAL TUBE HOLDER, show mouthpieces that strap to a patient's head. A mechanical device such as a clamp, screw or tie is then used to anchor a section of an endotracheal tube to the mouthpiece. The problems associated with such endotracheal tube holders is that they are expensive to manufacture, difficult to adjust and tend to constrict the diameter of the endotracheal tube as the endotracheal tube is anchored.
Simpler, lower cost endotracheal tube holders exist in the prior art that do not contain mouthpieces. Rather, such prior art endotracheal tube holders include a bracket that attaches directly to the endotracheal tube. The bracket provides a means by which the endotracheal tube itself can be directly strapped to a patient's head. Such endotracheal tube holders are exemplified by U.S. Pat. No. 5,398,679 to Freed, entitled HINGED ENDOTRACHEAL TUBE HOLDER HAVING BOTH A SAFETY CLAMP AND A SECURING CLAMP and U.S. Pat. No. 5,076,269 to Austin, entitled APPARATUS FOR RETENTION OF AN ENDOTRACHEAL TUBE. The disadvantage of such prior art endotracheal tube holders is that the brackets are often difficult to apply to the endotracheal tube. Furthermore, once a bracket is attached to the tube, it is very difficult to adjust the position of the bracket relative the tube.
One of the simplest prior art techniques used to anchor an endotracheal tube in place involves the use of a special strap, wherein the strap engages both the head and the endotracheal tube without the use of a mouthpiece or a bracket. Such prior art devices are exemplified by U.S. Pat. No. 5,205,832 to Truman, entitled ENDOTRACHEAL TUBE SUPPORT DEVICE and U.S. Pat. No. 4,844,061 to Carroll. In such prior art devices, the tube is coupled to the strapping either by friction (Truman patent) or adhesive (Carroll patent). With friction connections, the tube still often moves. With adhesive connections, the tube becomes glued into one position and cannot be adjusted when needed.
A need therefore exists in the prior art for an endotracheal tube holder that is low cost, simple to apply, retains the endotracheal tube firmly, is easy to adjust and does not constrict the endotracheal tube. This need is fulfilled by the present invention as described and claimed below.